Lindsay Ong-Tone

Aqueous humor penetration of gatifloxacin and moxifloxacin eyedrops given by different methods before cataract surgery

PURPOSE: To determine whether the penetration into the aqueous humor of 2 new fourth‐generation fluoroquinolone antibiotics, gatifloxacin (Zymar) and moxifloxacin (Vigamox) eyedrops, was affected by different methods of administration before cataract surgery. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: This prospective randomized study comprised 193 patients. The patients were divided into 2 main groups. One group received gatifloxacin eyedrops and the other, moxifloxacin eyedrops. Each group was subdivided into 4 subgroups. All patients received the drops 4 times a day starting 2 days preoperatively. The first subgroup did not receive any more antibiotics. The second subgroup received the antibiotic drops 3 times, starting approximately 2 hours preoperatively. The third subgroup received a wick soaked in a dilating mixture containing the antibiotic. The fourth subgroup received the wick and the antibiotic drops at the time of preparation for surgery. At the beginning of surgery, 0.1 mL of aqueous humor was aspirated, frozen, and sent under ice by courier to the Provincial Laboratory for analysis by high‐performance liquid chromatography. RESULTS: The study included 124 women and 69 men. The mean concentrations in the aqueous humor were 0.19, 0.82, 0.22, and 0.30 μg/mL in the 4 gatifloxacin subgroups, respectively, and 0.38, 2.16, 0.88, and 0.97 μg/mL in the 4 moxifloxacin subgroups, respectively. Analysis of variance showed the differences between the 2 antibiotics to be statistically significant. CONCLUSIONS: Moxifloxacin penetrated the aqueous humor better than gatifloxacin regardless of the method of administration. Both antibiotics penetrated the aqueous humor well when given in drop form. They reached and exceeded the minimum inhibitory concentration levels for the most common ocular pathogens causing endophthalmitis. Only moxifloxacin reached these levels when the wick was used.

Perioperative use of warfarin and aspirin in cataract surgery by Canadian Society of Cataract and Refractive Surgery members: Survey

Purpose: To survey the members of the Canadian Society of Cataract and Refractive Surgery (CSCRS) and identify their practices regarding the perioperative use of warfarin and acetylsalicylic acid (aspirin) in cataract surgery. Setting: Private practice, Regina, Saskatchewan, Canada. Methods: Members of the CSCRS were faxed a questionnaire that examined their perioperative management of patients being treated with warfarin and aspirin. Results: Of the 110 eligible participants, 82 returned a completed questionnaire, representing a response rate of 74.5%. Warfarin or aspirin was routinely stopped prior to cataract surgery by 25.6% of the respondents. The majority of surgeons who discontinued these medications reported doing so 3 to 7 days prior to surgery and resumed their use 1 to 2 days postoperatively. Topical anesthesia and clear corneal incisions were preferred by the higher volume surgeons. These surgeons were also less likely to discontinue either warfarin or aspirin preoperatively. Conclusions: The majority of the Canadian Society of Cataract and Refractive Surgery members do not stop either warfarin or aspirin for cataract surgery during the perioperative period.

Practice patterns of Canadian Ophthalmological Society members in cataract surgery—2009 survey

OBJECTIVE To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery. DESIGN A questionnaire consisting of multiple choice questions on cataract surgery practices was sent as an attachment by email to the members of the COS. PARTICIPANTS Seven-hundred and seventy-seven COS members with a valid email address in the Societys database. METHODS A 29-item questionnaire pertaining to cataract surgery practices was sent by email. A reminder email with the attached questionnaire was sent 3 weeks later. The survey data were descriptively analyzed with the Statistical Package for the Social Sciences (SPSS) v 16.0 software and the results compared with those from surveys by the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. RESULTS There were 161 responses. Of these, 30 members did not do any cataract surgery, and a further 8 responses were incomplete, therefore, 123 responses were analyzed. The majority of the respondents (69.1%) were between 40-59 years old. Phacoemulsification was the procedure of choice of all the respondents. Topical anaesthesia with clear corneal incisions was the most popular technique. Only 59.8% of respondents used a NSAID drop while 90.1% used a steroid drop postoperatively. CONCLUSIONS The practice patterns of the members of the COS for cataract surgery have not been reported before. This survey will serve as a baseline for future ones.

Use of a wick to deliver preoperative mydriatics for cataract surgery

&NA; Before cataract surgery at our institution, we traditionally dilated the pupils with 5 drops: proparacaine 0.5%, cyclopentolate 1%, phenylephrine 2.5%, flurbiprofen sodium 0.03% (Ocufen®), and ofloxacin 0.3% (Ocuflox®) at 15‐minute intervals given 3 times. This was work intensive for the nursing staff. Since September 2000, we have used a wick soaked in a dilating mixture containing cyclopentolate 1%, phenylephrine 2.5%, diclofenac sodium 0.1% (Voltaren®), and Ocuflox. Use of the wick has been beneficial and time saving to hospital staff.

Aqueous humor penetration of gatifloxacin and moxifloxacin eyedrops given in different concentrations in a wick before cataract surgery

PURPOSE: To determine whether the penetration into the aqueous humor of gatifloxacin (Zymar) and moxifloxacin (Vigamox) eyedrops was affected by altering their concentrations in the dilating mixture in which the wick used to dilate the pupil before cataract surgery was soaked. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: This prospective randomized open‐label study comprised 65 women and 35 men who were divided into 2 main groups. One group received 1 mL of the antibiotic in the dilating mixture and the other, 2 mL. Each group was divided into 2 subgroups, 1 for gatifloxacin and 1 for moxifloxacin. At the beginning of surgery, 0.1 mL of aqueous humor was aspirated, frozen, and couriered to the provincial laboratory for analysis by high‐performance liquid chromatography. RESULTS: In the first group, the mean concentration of gatifloxacin in the aqueous humor was 0.30 μg/mL ± 0.21 (SD) and of moxifloxacin, 0.97 ± 0.63 μg/mL. When the volume of the antibiotic in the dilating mixture was doubled, the mean concentration increased to 0.34 ± 0.25 μg/mL and 1.37 ± 0.79 μg/mL, respectively. Only the increased penetration of moxifloxacin was statistically significant. CONCLUSIONS: Moxifloxacin penetrated the aqueous humor better than gatifloxacin when given in a wick soaked in the dilating mixture before cataract surgery. Only the penetration of moxifloxacin increased significantly when the volume of the antibiotic in the dilating mixture was doubled. In both groups, only moxifloxacin reached and exceeded the minimum inhibitory concentration levels for the most common ocular pathogens causing endophthalmitis.

Pupil size with and without adrenaline with diclofenac use before cataract surgery

PURPOSE: To determine whether adrenaline in the irrigating solution is necessary when diclofenac eyedrops are used before cataract surgery. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: In this prospective randomized masked study, all patients used diclofenac eyedrops 2 days preoperatively. The pupils were dilated with a wick soaked in a dilating solution containing diclofenac. Patients were divided into 2 groups. One group had 0.5 mL of 1:1000 adrenaline in 500.0 mL of fortified balanced salt solution (BSS Plus) (adrenaline group). The other group did not (no‐adrenaline group). The horizontal diameter of the pupils was measured with calipers. RESULTS: The study included 207 patients. There were no surgical complications. In the adrenaline group, the mean pupil size was 8.19 mm ± 0.86 (SD) before the first incision, 8.14 ± 0.87 mm after phacoemulsification, and 8.14 ± 0.85 mm after cortical removal. In the no‐adrenaline group, the means were 8.19 ± 0.87 mm, 7.94 ± 0.99 mm, and 7.87 ±1.03 mm, respectively. The mean pupil constriction was 0.05 ± 0.21 mm in the adrenaline group and 0.33 ± 0.43 mm in the no‐adrenaline group. The difference was statistically significant (Mann‐Whitney test). Further analysis of preoperative pupil size showed a significant difference for smaller pupils only. CONCLUSIONS: When diclofenac eyedrops were used before cataract surgery, the smaller preoperative pupils constricted significantly less when adrenaline was added to the irrigating solution. This was not true for larger pupils. Thus, adrenaline in the irrigating solution does not appear necessary in eyes with large preoperative pupils.

Practice patterns of Canadian Ophthalmological Society members in cataract surgery—2014 survey

This was the sixth annual survey on the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery. The response rate was 36.6%. A similar number of respondents (35.3%) performed between 25 and 49 and 50 and 99 cataract surgeries per month. The majority of the respondents (56%) had been in practice for 20 years or more. All of the respondents performed phacoemulsification and used an antibiotic eye drop postoperatively. In this survey, there were some new questions dealing with the checklist before cataract surgery and femto-assisted cataract surgery. It is reassuring to see that 91% of the respondents were conducting the checklist before cataract surgery. A small number of the respondents (8%) were already doing femto-assisted cataract surgery. Of these, 57% volunteered that they were performing it routinely. Interestingly, 18.3% of the respondents volunteered that they would use a femtosecond laser within 1 year and a similar number would do so between 1 and 2 years. However, 28% said that they were not interested in this technology. Topical anaesthesia (90%) was still the most commonly used type of anaesthesia. About two thirds of these respondents would also use intracameral lidocaine (Xylocaine). The main wound size is definitely getting smaller. When first recorded in 2011, the most common wound size was 2.75 mm. This was used by 31.3% of the respondents; the 2.2-mm wound size was used by only 14% of the respondents. In 2014, 32.6% of the respondents were using a 2.2-mm wound size compared with 27.4% using a 2.75-mm wound size. Divide and conquer was still the most popular phacoemulsification technique (36.7%). This was followed by vertical chop at 28.6% and horizontal chop at 14.3%. The hydrophobic acrylic lenses (67.7%) were still the most commonly used lenses. The most popular ones were the 1-piece aspheric (46.8%) followed by the 1-piece aspheric with blue blocker at 45.2%. There was a marked increase in the use of the toric and multifocal intraocular lenses in 2011 when their use by the respondents was 73.5% and 43.4%, respectively. In 2009, only 47% of the respondents were using toric intraocular lenses, and only 29% were using multifocal lenses. In 2014, there was another marked increase in the usage of these lenses. The torics were used by 81.9% and the multifocals by 51.6% of the respondents. The use of nonsteroidal antiinflammatory drugs (NSAIDs) was similar to previous years at 63.8%. There was still a trend toward using these the respondents would start the drops immediately preoperatively and 36.2% would do so 3 days preoperatively, whereas in 2014, only 10% would start the drops immediately preoperatively and 45% started the drops 3 days before surgery. The use of a steroid eye drop has stayed much the same at 90.6% over the years. It is interesting to see that in the postoperative period, the use of an NSAID drop alone has stayed much the same at around 10%, whereas the use of a steroid eye drop only has been gradually declining. In 2009, it was 39.7%, whereas in 2014, it was 27.7%. There was a corresponding increase in the use of a combination NSAID and steroid eye drops, being 50% in 2009 and 64.9% in 2014. There was a marked increase in the number of respondents who corrected astigmatism at the time of cataract surgery. This was 43% in 2009 and 60.6% in 2014. Most of the respondents preferred to use a toric lens to correct the astigmatism. This has increased from 57.7% in 2009 to 84.7% in 2014. The number of respondents performing immediately sequential bilateral cataract surgery has increased from 9.5% in 2009 to 24.5% in 2014. However, only a small percentage (8.7%) of these respondents did so routinely. Certain trends in the practice patterns of the members of the Canadian Ophthalmological Society have been observed and maintained over the years.